MEDICARE: JULIET DURALDE MA, LPC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	89411	TX

General Provider Information

NPI Number	:	1285362285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIET DURALDE MA, LPC-A

Provider Business Mailing Address
First Line	:	3003 MEMORIAL CT APT 1243
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-5978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 S DAIRY ASHFORD RD STE 510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-2375
Country	:	US
Telephone Number	:	713-364-8645
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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